Agenda and minutes

To approve as a correct record the minutes of the meeting of the Adult Social Care, Health and Housing Overview and Scrutiny Panel meeting held on 24 July 2018.

To review the Actions Log arising from the Minutes, to include an update on the Task & Finish Groups’ progress and to provide an update on any issues arising since the last meeting.

To note the recommendations in the report from the Director of Adult Social Care, Health and Housing which advises the panel on the outcome of the sensitivity analysis of the impact of changes in homeless demand and effective prevention activity.

RESOLVED that the Minutes of the Adult Social Care, Health and Housing Overview and Scrutiny Panel held on 24 July 2018 be approved as a correct record, and signed by the Chairman.

Arising from the Actions Log, Action 1, Rohan Wardena, Transformation Programme Lead: Adult Social Care, Health and Housing provided the Panel with an update. 

The Panel were provided with a data set that illustrated the level of detail that could be provided and the key performance indicators (KPIs) being used to track the effect of the conversations approach. The Panel were reminded that this reporting system had only been in place since April 2018 following a systems upgrade and that this level of detail was not necessarily available prior to this date. The primary indicator being used was the number of new client contacts per month and the data represented an overall view of the effect of the conversations approach.  The Panel were advised that the data indicated that the conversations approach was making it easier for people to contact the Adult Social Care team and more people were being connected to support earlier with fewer clients going on to require long term care.

The Panel acknowledged that the conversations approach was widely welcomed and that the effects of the conversations approach were being monitored.

Rohan Wardena, Transformation Programme Lead: Adult Social Care, Health and Housing further described how across the country demand for health and social care was spiralling due to a growing and aging population and more complex needs, and this was putting the entire health and care system under pressure. However, through the transformation work, Bracknell Forest appeared to be bucking the national trend and demand for adult social care had gradually been reducing over the last 7 months although there had been a spike in June 2018. This was mainly due to the seasonal increase in demand from clients transitioning from Children’s Services to Adult Social Services. There had also not been the usual spiral in demand during the peak winter pressure period leading up to January 2018 that had been seen in previous years. The changes that had been delivered in Adult Social Care over the last 12 months had appeared to have been received positively and the risk of an increase in customer complaints had not materialised.

As a result of questions from the Members, Rohan Wardena, Transformation Programme Lead: Adult Social Care, Health and Housing explained:

• Spikes in demand could now be broadly anticipated because the management information system that had been developed was extremely powerful with a high level of granularity which enabled data to be tracked and analysed at customer level and included indicators to help identify individuals that might be at higher risk of crisis and would benefit from early intervention.  Not actively managing demand or focusing on prevention could result in a potential demand pressure £1.5m costs by year end.
• Social care is not free at the point of delivery and a person’s financial  ...  view the full minutes text for item 24.

Members are asked to declare any disclosable pecuniary or affected interests and the nature of that interest, including the existence and nature of the party whip, in respect of any matter to be considered at this meeting.

Any Member with a Disclosable Pecuniary Interest in a matter should withdraw from the meeting when the matter is under consideration and should notify the Democratic Services Officer in attendance that they are withdrawing as they have such an interest. If the Disclosable Pecuniary Interest is not entered on the register of Members interests the Monitoring Officer must be notified of the interest within 28 days.

Any Member with an Affected Interest in a matter must disclose the interest to the meeting.  There is no requirement to withdraw from the meeting when the interest is only an affected interest, but the Monitoring Officer should be notified of the interest, if not previously notified of it, within 28 days of the meeting.

There were no declarations of interest relating to any items on the agenda, nor any indication that Members would be participating under the party whip.

Any other items which, pursuant to Section 100B(4)(b) of the Local Government Act 1972, the Chairman decides are urgent.

There were no urgent items of business.

To receive submissions from members of the public which have been submitted in advance in accordance with the Council’s Public Participation Scheme for Overview and Scrutiny.

No submissions had been made by members of the public under the Council’s Public Participation Scheme for Overview and Scrutiny.

Sir Andrew Morris OBE Hon FRCP, Lead for the Frimley ICS to update the Panel on the progress of the Frimley Sustainability Transformation Partnership (STP) move to the Integrated Care System (ICS).

The Chairman welcomed Sir Andrew Morris OBE Hon FRCP, Lead for the Frimley ICS who provided an update to the Panel on the progress of the Frimley Sustainability Transformation Partnership (STP) move to the Integrated Care System (ICS) and the progress over the last couple of months.

The Panel were provided with the Frimley Health and Care System Plan On A Page and an update on the highlights of the transformation initiatives:

It was explained that the ICS isn’t an organisation.  It is a collection of partners who buy into what and how we want health and social care services delivered, glued together by a memorandum of understanding.

Bracknell was within Frimley’s ICS which was one of the most advanced in the country and had leading edge care.

Prevention and Self Care:

·         Bracknell provided residents with a roadmap to help themselves.

·         Work was pushing ahead on the transition from the Sustainability Transformation Partnership (STP) to the Integrated Care System (ICS)

·         Health services only had a 20% to 25% impact on health.  Housing and education have the biggest impact.

·         The Frimley ICS was working with West Berkshire and Heartlands ICS’s to pull together a series of data down to ward level on the health of the population, which could be scaled up and down.  This would help decision making.  Hot spots could be identified in localities to give a granular make-up of the population and how best to meet their needs.  For example: Slough might come out as the worst performer for health outcomes if compared to Surrey Heath, and the challenge would be to identify how to get Slough to meet the Surrey Heath standards of life expectancy.  John Lyle, Joint SRO A&E Delivery Board was leading this work on a 2 day a week basis with help from NHS Digital and NHS England.

·         Thought needed to be given to how we want people in their 80s and 90s to live.

·         Generally men die before women.  Consideration should be given to how we want lone elderly females to live.  

·         Local authorities could play a big part in the provision of lifestyle for older adults.  For example: Windsor wanted to map what sort of capacity would be required if older people wanted to sell their homes and move into accommodation that would be suitable for the elderly.  Currently their options would be limited. Mapping would provide the information necessary for planning for this scenario. 

·         At this stage, options for Local Authorities were often limited but they would need to link health with housing and education to decide and influence investment for the future.

Integrated Care Decision Making

·         Progress was being made on the integrated care team.  It was hoped it would be rolled over to East Berkshire to provide more care in people’s homes.  It would require investment but the principle of keeping people out of hospital was agreed.

GP Transformation

·         The intention to provide an 8 to 8 service was moving on to Saturdays and Sundays as an alternative  ...  view the full minutes text for item 28.

Rohan Wardena, Transformation Programme Lead: Adult Social Care, Health and Housing to demonstrate the ‘Help Yourself’ portal and to speak about the protection available for buying services outside of BFC monitored and quality assured services.

Rohan Wardena, Transformation Programme Lead: Adult Social Care, Health and Housing presented information and gave a live demonstration of the Help Yourself digital marketplace portal to the Panel. He spoke about the protection available for buying services outside of Bracknell Forest monitored and quality assured services.

Members were given the opportunity to view the portal on the screens in the Council Chamber or to interact with the portal using their own laptops and were guided to the landing page by typing “Bracknell Forest Help Yourself” into the Google search bar.

Alternatively the URL is www.helpyourself.bracknell-forest.gov.uk

Rohan Wardena, Transformation Programme Lead: Adult Social Care, Health and Housing provided the Panel with some background information to the Help Yourself portal.

The vision had been to set up a digital platform that would:

• Help connect people to their communities.
• Enable people to stay healthy for longer.
• Enable people to be well informed and feel supported to stay independent. 
• Be a useful resource for everyone to use.

It was explained that the portal helped to connect people to a wider range of care and support options, giving them more:

• Choice and control over their care.
• Supporting greater independence.

Focussing on people helped them makes the best use of collective assets.

Specifically within Bracknell, it was explained that the care market was fragile with fewer providers than in other areas and less provision to meet demand.  Bracknell does not enjoy the same level of price competition and full employment making it difficult to attract people into the care sector which was a factor in driving up the cost of care.  These factors forced the Adult Social Care team to consider a wider range of options through the use of personal care budget direct payments rather than traditionally commissioned services.

There had been an increase in the number of people taking up the direct payment option from 29% now to 47% which equated to 333 people, over a short period of time.

The digital market place was not a completely new idea.  Previously there was i-Hub but this hadn’t been used. 

The main objectives for the Help Yourself Portal were that it should be:

• A replacement for i-Hub
• An easy to use single source of information for everyone
• A marketplace platform to connect people to a wider range of support options
• A free resource for local organisations to promote what they do
• A resource for staff and partners to use to help connect people to activities, services and useful information
• Provide online tools to help people plan and make positive changes to their lives
• Provide information to help make informed choices and stay safe
• Organisations should own their own content

The Help Yourself Portal had been operational since Nov 2017.

When it was launched it had limited promotion and was to support the new conversations approach.

The portal had developed over time as a result of agile working.

On average now for 6 months there were:

• 600 visits a week of which  ...  view the full minutes text for item 29.

To consider the latest trends, priorities and pressures in terms of departmental performance as reported in the Quarterly Service Report for the first quarter of 2018/19 (April to June) relating to Adult Social Care, Health and Housing.  An overview of the key issues relating to the first quarter will be provided.

Panel members are asked to give advance notice to the Overview and Scrutiny Team of any questions relating to the Quarterly Service Report where possible.

The Chairman highlighted an error in the Quarterly Service Report (QSR) for Quarter One 2018/19 for Adult Social Care, Health and Housing on page three of the report (page 27 of the agenda.)  First paragraph, seventh line down, the figure quoted is £478 overspend.  This should be £478K overspend.

Nikki Edwards, Executive Director: People confirmed that no questions about the QSR had been submitted in advance of the meeting and provided some further information relating to the QSR.

·         The overspend of 478K was down to 4 clients who required complex packages however the trend over time was downwards in the right direction.

·         The area of good performance was highlighted relating to the public health indicators and the successful bid to the LGA Digital Innovation Programme.

·         Sickness levels had already been clarified during the meeting.

A recent transformation programme update showed current RAG ratings.

In response to questions from the Panel, Nikki Edwards, Executive Director: People advised that she could provide a detailed picture of trend over time when the savings plans had been revisited.

Demand led services could be skewed by small numbers of people, the new data would provide a better indicator.

Nikki Edwards, Executive Director: People suggested that she could bring the tool to demonstrate at the next meeting and confirmed that the new dashboard approach work was under way.

To consider scheduled Executive Key and Non-Key Decisions relating to Adult Social Care, Health and Housing.

Members were advised by Councillor Dale Birch, Executive Member: Adult Social Care, Health and Housing that

·         A new Chairman of the Joint Safeguarding Panel was appointed last week and the Joint Safeguarding Adults Board was developing from there.

·         The Community Centre and Health Care Hub at Blue Mountain had been through the Portfolio review Group (PRG)

Arising from the Actions Log, Action 10, Development of Overview and Scrutiny Work, the Panel discussed the Development of the Overview and Scrutiny Work Programme 2018/19:

The Chairman referred to the legal advice from Simon Bull, Assistant Borough Solicitor, which was circulated by email on 4 September 2018 to Members, Substitute Members, and Co-opted Members of the Adult Social Care, Health and Housing Overview and Scrutiny Panel by Kirstine Berry, Governance and Scrutiny Co-ordinator, providing clarification about what information can be accessed by Councillors.

Three Members of the panel planned to attend the Centre for Public Scrutiny “National Health Scrutiny and Assurance Conference” on Friday 14 September.  It was recognised that Frimley ICS was one of the leading ICS’s at the moment and so was still developing.  Benchmarking what other local authorities do to scrutinise health may not be beneficial as Frimley ICS was leading the way and breaking new ground. It was hoped that some insights for scrutiny could be taken from the conference.

Other suggestions were made to develop the work programme:

·         Interface with Bracknell Forest Healthwatch to obtain the facts and figures for scrutiny.  Healthwatch could provide guidance on what to look for from health providers.

·         Interrogate the ICS when things go wrong to establish why things had failed and to call in parts of the system.

·         Maintaining a focus was recommended.  Identification of a single issue to be investigated.  There are only 5 or 6 months left until Borough Councillor elections to realistically achieve anything for the work programme.  The work should have a strong focus, be undertaken quickly and effectively and make strong recommendations.

·         Mental Health could be scrutinised.

Nikki Edwards Executive Director: People clarified a suggestion that bespoke QSR’s and KPIs could be created. It was explained that the contents of the QSRs were scorecards that were directed by the requirement to provide statutory information to be reported against to Government.  If new KPIs and QSRs were created, officer time capacity would be required to support and maintain them.

It was suggested that members could use the unique positions they were in as Councillors to identify and focus on the issues that were troubling residents for scrutiny.

Members agreed that “GP surgeries” was the issue that residents routinely highlight and the inability to get appointments.  There was discussion about the work that had been done previously and the impact of the report on GP capacity in 2016.

It was observed that there are parts of the system that have not improved in the last few years and were persistently getting worse in relation to GP capacity.

It was clarified that the current task and finish group working with GP surgeries was working to establish best practice data and capacity issues were not within its scope.

It was suggested that, as a number of panel members had provided apologies for the meeting, that making a decision on the work programme was probably not appropriate and that the subject should be revisited again after the CfPS  ...  view the full minutes text for item 32.

The next meeting of the Adult Social Care, Health and Housing Panel has been scheduled for 6 November 2018.

The date of the next meeting will be 6 November 2018 at 19.30